1. HIV among older adults in Zimbabwe: Ageing with HIV or seroconverting after age 50? J. Negin 1, C. Nyamukapa 2,3, J. Eaton 3, N. Schur 3, A. Takaruza 2, P. Mason 2,4, S. Gregson 2,3 Counting the Hard to Count AIDS 2014, 23 July 2014 1 University of Sydney School of Public Health, Australia, 2 Biomedical Research and Training Institute, Harare, Zimbabwe, 3 Imperial College School of Public Health, London, United Kingdom, 4 University of Zimbabwe, Harare, Zimbabwe

2. Background – ageing of the cohort With ART scale-up, more people are living longer with HIV 3 million PLHIV aged ≥50 years in Africa Increasing proportion of PLHIV are aged 50+ Proportion of PLHIV aged over 50yrs, Manicaland, Zimbabwe, 2001-2011 RESEARCH QUESTION: What percentage of older adults living with HIV have “aged with HIV” and what percentage seroconverted at age 50 or older?

3. Data from a population-based cohort in eastern Zimbabwe Five survey rounds completed: 1998 to 2011 Participants completed a 1-2 hour interview; dried blood spots taken & tested for HIV Eligibility criteria included males aged 17–54 & females aged 15–44 (expanding to 15-54 for both sexes in 2003) Methods in brief

4. Total of 58099.9 person years among 11,883 individuals - average of 4.89 years per person Incidence rate of 1.22 per 100 person years overall Incidence rate of 0.69 per 100 person-years in 50+ Of 80 people in the dataset aged 50+ at last survey and living with HIV (for whom date of sero-conversion was available), 45 (56.3%) sero-converted at ages ≥50 - rather than aged into their 50s already with HIV 31.2% of the older individuals sero-converted in the last 3 years Sero-conversion is occurring among older adults Age GroupSexSero-conversionsPerson YearsIncidence Rate per 100 PY All 71058,1001.22 Male27422,4651.22 Female43635,6351.22 50+All456,4990.69 Male222,2280.99 Female234,2710.54

5. Older adults can no longer be neglected by prevention & treatment services Targeted services are needed As people survive longer on treatment & HIV incidence is reduced, HIV among older adults will become central to the HIV response Issues of multi-morbidity will become more prominent in treatment programs Conclusions

6. Acknowledgements We would like to express our sincerest gratitude to the data collection & data entry team in Zimbabwe for doing a wonderful job! We thank Wellcome Trust for funding the Manicaland Project. 6 Contact joel.negin@sydney.edu.au